Abstract
We report a case of flexor tenosynovitis of the finger as a manifestation of sarcoidosis.
The patient, a 53-year-old woman complained of swelling and limited motion in her left middle finger. Her past medical history revealed that she had been diagnosed as having sarcoidosis 2 years previously. The physical examination showed slight tenderness, and the skin over the swollen area was reddish. Active range of motion of the distal and proximal interphalangeal and metacarpophalangeal joints was 0-20, 0-50 and 0-65 degrees, respectively.
Laboratory findings were normal except, for an elevated sedimentation rate (25mm/hr) and a high angiotensin-converting enzyme level (42.3IU/L). Plain radiographs of the left hand revealed nothing abnormal. A chest X-ray showed bilateral hilar lymphadenopathy. A magnetic resonace image of the left hand indicated tenosynovitis of the middle finger.
Surgical tenosynovectomy was performed, and the histologic findings of the tenosynovium indicated noncaseating epithelimoid granulomas. Cultures of the tenosynovium for bacteria and tuberculosis were negative. The patient's hand was splinted for 2 weeks, after which she was allowed to do active exercises. There was no recurrence of tenosynovitis 7 months after surgery.
